Radiocephalic Fistula Recovery Using the Brachial Vein and Forearm Basilic Vein: A Case Series and Literature Review

Abstract

Vascular access dysfunction is a serious problem in dialysis units. Some patients have complex dysfunctions that are difficult to resolve. In this article, we report the case a of two patients with radiocephalic arteriovenous fistulae (RC-AVF) who had stenosis/occlusion of the forearm median vein and where we used the basilic vein of the forearm as a solution. We reviewed the use of this surgical solution in RC-AVF. Two male patients on hemodialysis exhibited stenosis/occlusion of the forearm median vein. The forearm basilic vein was isolated and rotated toward the forearm median vein in order to solve RC-AVF problems. One patient had fistula thrombosis 5 months after the procedure, while for the other patient, the fistula continues to work without problems. Literature describes only a few cases using the forearm basilic vein or the brachial vein for fistula recovery. This procedure increased the patency of fistulas. This approach has been proven to be a good solution for solving outflow problems using the superficial or deep veins, increasing fistula patency and avoiding the need to place a central venous catheter and all the related complications.

Cubital vein transposition for a distal radiocephalic fistula complicated by outflow obstruction

“…Endovascular treatment is vital to maintain functional patency in the mid-and long term. Norton de Matos et al 6 1 Median cubital vein thrombosis 18 60 Norton de Matos et al 7 2 Forearm median vein thrombosis 5, 5 24, 30 Glowinski et al 8 5 NA NA NA AVF: arteriovenous fistula; NA: not available.…”

“…17 Current experience on cubital vein transposition as an outflow rescue is based on only four patients from two centers, to the best of authors' knowledge. [6][7][8] Early results are reported as successful but no clear data exist with respect to primary and secondary patency (Table 2). We believe, however, that many more cases have been treated by a similar approach, being however unreported.…”

Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report

“…This technique can be used when the vein segment is long enough to be rotated into the median basilic vein. [4][5][6] Such procedure enables increasing the diameter of the basilic vein and the subsequent basilic transposition in the first stage. 8 The endovascular intervention may be a good option to solve this problem, with or without stent placement.…”

“…Maintaining the distal access is a challenge for both the dialysis team and the vascular surgeon. Several interventions for the recovery of a distal AVF with outflow problems are described in the literature 4 . Rotation of the basilic vein in the forearm 5 or of the brachial vein in the elbow may be solutions for the recovery of a distal AVF with outflow problems 6 .…”

Radial‐cephalic fistula recovered with graft interposition from the brachial artery into the cephalic vein—Patient with two arteriovenous fistulas

“…The radio‐cephalic arteriovenous fistula (RC‐AVF) is considered the best access for patients requiring hemodialysis (HD) treatment 1–3 . RC‐AVF has fewer complications, especially steal syndrome, higher fistula flow, and venous hypertension syndrome, when compared to proximal fistulas 4 . However, this fistula type has a high rate of primary failure and maturation problems.…”